Dipartimento di Sicurezza e Bioetica - Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy.
Dipartimento di Sicurezza e Bioetica - Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy.
Diagn Microbiol Infect Dis. 2024 May;109(1):116205. doi: 10.1016/j.diagmicrobio.2024.116205. Epub 2024 Feb 2.
External ventricular drain-related cerebrospinal fluid infection represents a fearsome complication of neurosurgical interventions. Although vancomycin represents the standard of care for methicillin-resistant CoNS healthcare-associated ventriculitis, resistance phenomena have been described. We reported a case of a persistent external ventricular fluid drain infection after device removal by pandrug-resistant Staphylococcus epidermidis successfully treated with intravenous ceftaroline in combination with fosfomycin and vancomycin. No evidence regarding pandrug-resistant S. epidermidis therapy currently exists to our knowledge. In this case, the S. epidermidis phenotype emerged during the therapy course, possibly due to initial device retention, biofilm formation and the host immune impaired response. Despite being poorly studied in vivo, ceftaroline may be considered an option when other alternatives are unavailable, thanks to its described activity against CoNS in vitro. This case extends the experience with ceftaroline for central nervous system infections suggesting it could also be used in high antimicrobial resistance settings for immunocompromised people.
外引流相关的脑脊液感染是神经外科干预的可怕并发症。虽然万古霉素是耐甲氧西林凝固酶阴性葡萄球菌（CoNS）相关脑室炎的标准治疗方法，但已描述了耐药现象。我们报告了一例由泛耐药表皮葡萄球菌引起的持续的外引流脑脊液感染，在移除装置后，联合静脉注射头孢洛林、磷霉素和万古霉素成功治疗。据我们所知，目前尚无针对泛耐药表皮葡萄球菌治疗的证据。在这种情况下，表皮葡萄球菌表型可能是由于初始装置保留、生物膜形成和宿主免疫受损反应导致的，在治疗过程中出现。尽管在体内研究不足，但由于其在体外对凝固酶阴性葡萄球菌的描述活性，头孢洛林在其他替代方案不可用时，可能被认为是一种选择。该病例扩展了头孢洛林在中枢神经系统感染方面的应用经验，表明它也可用于免疫功能低下人群的高抗微生物耐药环境中。
